| NPI | 1447354147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 103811) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: MA 170876) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2019-07-17 |